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FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Office of the Building Inspector
Town Hall
Southold, N.Y.
CERTIFICATE OF OCCUPANCY
No Z-22300 Date MAY 6, 1993
THIS CERTIFIES that the building ALTERATION
Location of Property 515 SOUND AVENUE PECONIC, NEW YORK
House No. Street Hamlet
County Tax Map No. 1000 Section 67 Block 2 Lot 2
Subdivision Filed Map No. Lot No.
conforms substantially to the Application for Building Permit heretofore
filed in this office dated JANUARY 30, 1992 pursuant to which
Building Permit No. 21209-Z dated FEBRUARY 3, 1993
was issued, and conforms to all of the requirements of the applicable
provisions of the law. The occupancy for which this certificate is
issued is ENCLOSE EXISTING PORCH OF ONE FAMILY DWELLING AS APPLIED FOR
The certificate is issued to MARION MURDOCK
(owner)
of the aforesaid building.
SUFFOLK COUNTY DEPARTMENT OF HEALTH APPROVAL N/A
ELECTRICAL INSPECTORS NO. 2408 - MARCH 19, 1993
PLUMBERS CERTIFICATION DATED N/A
ui ding Inspector
Rev. 1/81
FORK NO. f
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
SOUTHOLD, N. Y.
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
NN9 21209 Z Date . . I9 3
Permission is hereby grated to:
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at premises located at .Tr...
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County Tax Map No. 1000 Section .......j6....7.......... Block .......g Lot No....
pursuant to application dated ......~b 19.2.2-1 and approved by the
Building Inspector.
Fee S...Z.s....
uildi Inspector
Rev. 6/30/80
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ADDITIONAL COMMENTS:
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M-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION 1ST [ J ROUGH PLBG.
[ J tNDATION 2ND [ ] INSULATION
ING [ ] FINAL
REMARKS:
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DATE INSPECTOR P'
Form No. 6
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN HALL
765-1802
APPLICATION FOR CERTIFICATE OF OCCUPANCY
A. This application must be filled in, by typewriter OR ink and submitted to the building
inspector with the following: for new building or new use:
1. Final survey of property with accurate location of all buildings, property lines,
'streets, and unusual natural or topographic features.
2., Final Approval from Health Dept. of water supply and sewerage-disposal(S-9 form).
3. Approval of electrical installation from Board of Fire Underwriters.
4. Sworn statement from plumber certifying that the solder used in system contains
less than 2/10 of 1% lead.
5. Commercial building, industrial building, multiple residences and similar buildings
and installations, a certificate of Code Compliance from architect or engineer
responsible for the building.
6. Submit Planning Board Approval of completed site plan requirements.
B. For existing buildings (prior to April 9, 1957) non-conforming uses, or buildings and
"pre-existing land uses:
1. Accurate survey of property showing all property lines, streets, building and
unusual natural or topographic features.
1 2. A properly completed application and a consent to inspect signed by the applicant.
If a Certificate of occupancy is denied, the Building Inspector shall state the
reasons therefor in writing to the applicant.
C. Fees
1. Certificate of Occupancy - New dwelling $25.00, Additions to dwelling $25.00,
Alterations to dwelling $25.00, Swimming pool $25.00, Accessory building $25.00,
Additions to accessory building $25.00. Businesses $50.00.
2. Certificate of Occupancy on Pre-existing Building - $100.00
3. Copy of Certificate of Occupancy - $5.00 over 5 years - $10.00
4. Updated Certificate of Occupancy - $50.00
5. Temporary Certificate of Occupancy - Residential $1155.00/, Commercial $15.00
Date ......$1
New Construction........... Old Or Pre-existing uilding../
C
Location of Property...
Ck .
House No. Street Hamlet
Onwer or Owners of Property ...++/....AIA' ,
County Tax Map No 1000, Section ...1W.l....... Block....'7Z......... Lot.......
Subdivision /.FillQed Map............ Lo/~t.............
.
Permit No.. p7~a0 ? ,Date Of Pee/rmit.. 1 r!. , , ,Applicant... _-Vz~,/~%~P
Health Dept. Approval....... ``//lf ............Underwriters Approval....... v
Planning Board Approval......./110...........
Request for: Temporary Certificate........... Final Certicate....l~....,
Fee Submitted: ° C-W
APPLICANT
C0-2- d,? 300
M-1802
BUILDING DEPT.
INSPECTION
[ ] FOUNDATION 1ST [ ] ROUGH PLBG.
FOUNDATION 2ND [ ] IN LATION
FRAMING [ FINAL
REMARKS: a
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DATE L~ INSPECTOR t1l
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DATE;
NOTIFY BU1L.),4G DEPART
FOL-- 4 PIV FOR THE
LOWING INSf LOTIONS
FOR S7e'~i.11P3t1)
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4. FINAL
FEE COMPLETE G~ p UST
ALL fJON57Gt rr~
I=- THE REQUIREMENTS OF THENYs
STATE ;j Al EN
- "i ODE$• NOT RESPONSIBLE FOR
DESIGN OR CONSIBI I(
BOARD OF HEALTH
FORM NO.1 3 SETS OF PLANS
TOWN OFSOUTHOLD SURVEY
FE6 - BUILDING DEPARTMENT CIIECC . . .
f egg TOWN HALL SEPTIC FORK
SOUTHOLD, N.Y. 11971
TEL.: 765-1802
~s CALL
Examined 19 F.22~ MAIL TO:
Approved IV,,2Permit No.~l .vU..~
Disapproved, a/c
uild' Inspector)
APPLICATION FOR BUILDING PERMIT
p ('r '
Date 19.1
INSTRUCTIONS
a. This application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with 3
sets of plans, accurate plot plan to scale. Fee according to schedule.
b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets
or areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appli-
cation.
c. The work covered by this application may not be commenced before issuance of Building Permit.
d. Upon approval of this application, the Building Inspector will issued a Building Permit to the applicant. Such permit
shall be kept on the premises available for inspection throughout the work.
e. No building shall be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupancy
shall have been granted by the Building Inspector.
APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the
Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or
Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described.
The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to
admit authorized inspectors on premises and in building for necessary inspe tions. n 1 9
(Signature of applicant, or name, if a corporation)
(Mailing address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
Name of owner of premises 'y
:.14+ ~ a~ . u. l ..~.(x ~749~t 4 e
(as on the tax roll or latest-deed)
If applicant is a corporation, signature of duly authorized officer.
(Name and title of corporate officer)
Builder's License No. .h~ . .
Plumber's License No .
Electrician's License No .
Other Trade's License No .
1. Location of land on which proposed work will be done. .
45 5......... ).0lA.n ~C-
House Number Street amlet
County Tax Map No. 1000 Section (6".. 01`... Block Lot
Subdivision Filed Map No. Lot...............
(Name)
2. State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Existing use and occupancy ~dT erl . t{.: J. ; . s., .
,i<,,,4 '+H'
b. Intended use and occupancy
3. Nature of work (check which applicable): New Building Addition Alteration .
Repair Rem oval Demolition Other Work
(Description)
4. Estimated Cost . .
ZI
r Fee aY.c
(to be paid on filing this application)
5. If dwelling, number of dwellingllunits . Number of dwelling units on each floor
If garage, number of cars
6. If business, commercial or mixed occupancy, specify nature and extent of each type of use .
7 Dimensions of existing structures, if any: Front Rear Depth
Di
g berof Stories
Dimensions o same structure with alterations or additions: Front Rear
Depth ..Height Number of Stories
8. Dimensions of entire new construction: Front Rear Depth
Height Number of Stories
9. Size of lot: Front . . . . . . . . . . Rear . . . . . Depth
0 Zone or use district in which ' • • • Name of Former Owner
11. are situated .
12. Does proposed construction v~igla_te any zoning law, ordinance or regulation: .....Mo........... .
13, Will lot be regraded 1•~ Will excess fill be re oved from premises: Ye
14. Name of Owner of premises , . . NILt CGQ(XV Address .)A1 . Us(. Phone No.. ?40. .41 .
.................Address ...................Phone No................
Name Name of Contractor of property . . . . . Address Phone No...............
15. Is this within ,300 feet of a tidal wetland? *Yes........ No..~.....
*If yes, Southold Town Trustees Permit may be required.
PLOT DIAGRAM
Locate clearly and distinctly allli buildings, whether existing or proposed, and. indicate all set-back dimensions from
property lines. Give street and block number or description according to deed, and show street names and indicate whether
interior or corner lot.
Y T
ae
STATE OF N Ii
E~ I G M.S
COUN'T'Y O q
(Name of indi al ' • . ' ' • • being duly sworn, deposes and says that he is the applicant
signing contract)
above named.
Heisthe
(Contractor gent, orporate officer, etc.)
of said owner or owners, and is duly'I authorized to perhave performed the said work and to make and file this
application; that all statements contained in this application are true to the best of his knowledge and belief; and that the
work will be performed in the manner set forth in th application filed therewith.
Sworn to before me this
day of 19 (q3
Notary Public, County
CLAIRE L. GLEWG
Notary Public, State of NO NYork
No.4879508
Qualified in Suffolk County -0/~ (Signature of applicant)
Commission Expires Decembdr 8,10.L.
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